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Public health staff need to prepare for the “unexpected,” conference is told

BMJ 2006; 333 doi: (Published 14 September 2006) Cite this as: BMJ 2006;333:570
  1. Claire Laurent
  1. Warwick

    Doctors and other professionals working in the field of public health need to prepare “for the unimaginable and unexpected” and work with greater flexibility if they are going to provide a service that is fit for the future, delegates at the UK Health Protection Agency's annual conference in Warwick this week were told.

    Stephen Palmer, director of local and regional services at the agency, said that in the future work to protect public health would need to be undertaken within a paradigm of sustainable communities. This would require “integration across separate domains, so that we specialise not just in infection control but how to cope with prison health issues and deal with all types of environmental threat.” Health protection in the 21st century will need a multiskilled workforce that can work across boundaries, stepping outside traditional specialties, he said.

    “We are not just an infection control service. Some of our health protection units are spending 13% of their time on chemical incidents,” said Professor Palmer. “The focus will be on local teams of critical mass. We need to be the custodians of health protection.”

    He said that the service was “not yet grappling with the public's perception of risk and reality” and that this needed to be addressed. Citing as an example the fire at the Buncefield oil depot in Hertfordshire in December 2005, he said that a survey carried out by the agency found that between 30% and 40% of the local population reported that they had symptoms in the week after the fire. “But if we did such a survey at any other time we would find 30% to 40% of [people had] symptoms,” said Professor Palmer. “This was a potentially massive burden created for the NHS.” He said that toxin assessment at Buncefield showed that no risk was posed to the public, but nevertheless the public had fears of risks, and such perceptions needed to be managed.

    “There are new areas of risk assessment and risk communication which are critical to doing something effective about these threats,” he said.

    Professor Palmer called for greater consistency among health protection units across the country to eliminate disparity in activities. “HPUs [health protection units] are roughly of equal size, but you will see a range in the proportion of resources spent on different areas.”

    He said this was partly the result of regional differences: “A lot of urban areas have tuberculosis; a lot of rural areas don't.” But much of the variation was because units have different local arrangements with the NHS, so one unit might spend 7% of its resources on vaccine related issues while another might spend 19%. Spending on sexual health services also varied widely, another area of concern, he said.

    Professor Palmer said partnership working across boundaries was essential. “We need multiskilled people who can work in a multidisciplinary team with a flexibility that is not innate to us and our organisation,” he said. (See Personal View, p 608.)

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